GENERAL MEDICINE ASSESSMENT
BIMONTHLY BLENDED ASSESSMENT
K MAHENDRA
ROLL NO 56
3RD SEMESTER STUDENT
I have been given the following cases to solve in an attempt to understand the topic of 'PATIENT CLINICAL DATA ANALYSIS' to develop my competency in reading and comprehending clinical data including history taking, clinical findings, investigations and diagnosis and come up with a treatment plan.
Below is the link to the questions asked in the assignment.
http://medicinedepartment.blogspot.com/2021/07/medicine-paper-for-july-2021-bimonthly.html?m=1
QUESTION 1
Competency tested for peer to peer review and assessment :
Please go through one students entire answer paper from the below link, the one who is closest to your own roll number
http://medicinedepartment.blogspot.com/2021/07/2019-batch-medicine-department-online.html?m=1
and share your peer review of each answer with your qualitative insights into what was good or bad about the answer.
ANSWER
https://rohit1425.blogspot.com/p/general-medicine-assignment.html
The whole assessment was kept brief and simple. The factual information from the investigations where put forth and understanding of the cases was given.
Reviews to all the Questions answered:
As he has done about 10cases,in each case he has given the best review,which was very useful for us to understand about the case details.
He gone with good investigations and given a better explanation for every case and he followed steps in investigation.
Everything is fine and fare but a little more explanation is needed for every case other than that every case is explained in a proper way for easy understanding. The review mentioned by him to study is too little needed some more information to understand the case.
QUESTION 2
Share the link to your own case report of a patient that you connected with and engaged while capturing his/her sequential life events before and after the illness and clinical and investigational images along with your discussion of that case.
Case: A 52-year-old man presented to the OPD with Chief Complaints of abdominal distension from the past 7 days.
link: https://mahendrakancharla444.blogspot.com/2021/07/elog-gm-case-56-mahendra.html
QUESTION 3
Please go through the cases in the links shared and provide critical appraisal of the captured data in terms of completeness, correctness and ability to provide useful leads to analyse the diagnostic and therapeutic uncertainties around the cases shared.
patient with low back ache and renal failure :
ANSWER
1) AKI
A patient with acute kidney injury
Patient presented due to abdominal pain and lower back back after an ijuty while wightlifting D
Diagnosed as AKI secondary to UTI
https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1
The blogg is not soo clear . The conclusion of how they got to a conclusion AKI with UTI could be explained more clearly . How was the lower back pain ruled out is also not explained .
2) Acute on CKD
http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html
The patient presented withwith lower back pain and dribbling of urine from 10 days .he also had bilateral pedal edema and shortness of breath .
He was diagnosed as with acute renal failure assosiated with multifocal spondilitis .
The blog is very impressive all the symptoms like the cause of seizers and delirium explained and day wise treatment updated .
3)
CkD
https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1
49 yr old female with generalised waekness and vomiting .she was operated perviously for haemorroids and was on nsaids
She was diagnosed with chronic interstitial nephritis secondary to plasma cell dysraisias ( multiple myeleoma - 70 % plasmacytosis ) .
The case was comprehensive and consise and we'll excuetied . All the nessesary information was provided and even the investigation with reports and histology slides of the plasma cells was also uploaded .
4)acute renal failure with lower back pain
casereports.bmj.com/content/2009/bcr.03.2009.1726
A 47 yr old man presented with uremic symptoms and oligouria ,lower back pain and altered snesorium .renal biopsy showed moderate tubulo-interstitial nephritis with mild global glomerular sclerosis.
Altered sensorium was because of uremic encepalopathy .lower back pain due to osetolytic lesions due to plasma cell dysraisias.
The bone marrow findings are suggestive of Waldenstrom’s macroglobulinaemia (WM).
The blog is exceptionally done explaining each symptom and gradualy diagnosis and treatment . The case scenerio and complaints was explained in detail with duration.
5) patient with coma and renal failure
https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html
A 35 yr old female presented with chest pain abdominal pain ,diarrheal with bloddy discharge , shortness of breath , she was a known case of diabetic .
She also had bedsores and usg showed pyleonephritis
The patient was comatised and put on mechanical ventilator but she gradually miraculously recovers .
Diagnosed as AKI secondary to diabetic ketoacidosis.
The case is very well done , history and complaints were chronologically taken .it is very detailed and day wise investigations treatment ,and even images are uploaded of every investigation done .
6) patient with coma and renal failure
https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1
52 yr old presented with cheif complaints of abdominal distension, constipation ,pedal oedma , hiccups since morning .he is a known case of diabetes.he was a alcoholic
Patient is diaonosed and infective endocarditis wait AKI assioasited with alcholic liver diasease with multiple infarcts in the bilateral cerebral and cerebrellar regions .
Might be septic or uremic or diabetic encepalothy .
Case is well explained with pictorial depictions , and the vedioes of 2 d echoes was also provided . A detailed treatment plan is given .
7) patient on acute in CKD
https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1
52 yr old man presented with fever and pus in urine .He is a known case of diabetes mellitus type 2 .
He had suffered from Burning micturation which was due to prostomegaly and was coorected by a surgery TURP.
But complications developed do it and patient reported with generalised weakness and decreased appetite, drowsiness , SOB respectively on his consecutive visits .
Diagnosis was renal AKI secondary to urosepsis secondary to b/l hydroureterosepsis.
Diabetic nephropathy secondary to CKD.
The log was exceptionally done .it is clear and precise . Comaprisons between before and after treatment was done and diagnosis was made clear.
8)
https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1
48 yr old man with SOB .he is known case of HT and DM.2 yrs back diagnosed with chronic renal failure .he also had issues of orthoepenea and bendopenea in the past .
Pedal oedma present .
Diagnosis-HFrEF secodbary to CAD ,CRF
The case is comprehensive and well presented .consise research was done and even links of very such cases presented .
9)
https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1
60 yr old female with anasarca and SOB.complaints of pedal oedma and decreased urinary output .she has 10-15 episodes of SOB in a yr .
She is having cor pulmonale. Might hav suffered uremic nephropathy .
The case was not so clear as there were many assumptions in the condition and patient was symptomatically treated .
10)
https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1
Alcholic hepatitis and AKI secondary to gastroenteritis
A 43 yr old man presented with cheif compaints of loose stoools , oedma and abdominal distension
The case is done precisely with chronological history and the day wise observations and treatment .the case is clear and pictorially assisted well .
11)
https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1
Acute kidney injury secondary to urosepsis
A 60 yr old female with decreased urinary output ,pedal oedma, burning micturation ,and fever. Happened before as well treated with dialysis.
The case is very clearly presented .It is well explained and understandable.all the nessesary information is given ,like the investigation,reports ,symptoms ,pics,treatment .
12)
http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1
Pancreatitis in a chronic alcholic with AKI
A 31 yr male presebted with pain in abdomen ,SOB and vomitings.hard liqour and kahini addict.diagnosis as acute pancreatitis with AKI and b/l pleural effusion.
Log was clear and precise .the case summary has been provided which helps in easier understanding .
QUESTION 4 : Please analyse the above linked patient data by first preparing a problem list for each patient and then discuss the diagnostic and therapeutic uncertainty around solving those problems ,include the review of literature around sensitivity and specificity of the diagnostic interventions mentioned for each patient.
ANSWER :
●AKI :
Problem list :
1. Lower abdominal pain
2. burning Micturation
3. Low back ache after lifting weights
4. Dribbling/decrease of urine output
5. fever
6. Shortness of breath
7. Blurring of vision
8. Hypertension
9. Mild hepatomegaly with grade - 1 fatty liver
10.High blood urea
11.High creatinine
12. Low Na and cl
Diagnostic and therapeutic uncertainty :
The investigations done in this patient are hemogram, CUE, RFT, ECG, 2D echo, chest x ray, FBS, PLBS, HbA1C.
- on ultrasound sonography test of abdomen it was found that the patient has Mild hepatomegaly with grade -1 fatty liver.
-The serum electrolytes were low.
-The provisional diagnosis was found to be : Acute kidney injury secondary to UTI associated with denovo DM-2.
-With right heart failure.
-With known case of hypertension (not on Rx).
-AKI causes a build up of waste products in your blood and makes it hard for your kidneys to keep the right balance of fluid in your body.
The treatment for this patient is -
He was started on IVF of ringer lactate, salt restriction to less than 2.4 gm/day.
- Injection TAZAR , which is used to treat urinary tract infections and various hospital acquired and ventilator associated pneumonia and uterine infections.
- Injection PANTOP
-Injection Thiamine
-Syrup lactulose
●Acute on CKD:
Problem list :
-Low back ache
-Dribbling of urine
- Pedal edema
- Shortness of breath
- Increased voluntary movements of both upper limbs
- Weakness,tingling sensation and numbness of both upper and lower limbs
- High blood urea ,creatinine, uric acid
Diagnostic and therapeutic uncertainty :
-The investigations done in this patient are ECG,RFT,Hemogram,ABG,Serum electrolytes, blood urea,USG abdomen,LFT.
- The provisional diagnosis was found to be :
●Acute renal failure (intrinsic)
●Grade 1 L4-L5 spondylodiscitis
● Hyperuricemia secondary to renal failure
●Uraemia induced tremors (resolved)
●Delirium secondary to septic /uremic encephalopathy
The treatment for this patient is :
IVF - NS -0.9%
Inj.Tazar
Inj. Lasik
Inj.pantop
Nebulization salbutamol
Tab PCM
Foleys catheterization
10 units of insulin IV
Problem list :
-Muscle aches
-fever
-Generalised weakness
-Vomiting
- High blood urea and creatinine
Diagnostic and therapeutic uncertainty :
- Serum electrophoresis showed M-band in gamma region.
-Bone marrow aspiration showed plasma cell dyscaria,probably multiple myeloma (plasmacytosis 70%). Mild to moderate supression of all cell lineages.
-There's is no significant changes in ECG .
-And no abnormality found in 2D echo.
- The patient was diagnosed as CHRONIC INTERSTITIAL NEPHRITIS secondary to plasma cell dyscariasis,(multiple myeloma -70% plasmacytosis).
The treatmentfor this patient is :
- T. PAN 40mg /PO / OD
- oral fluids upto 1.5 - 2 lit / day
- Protein - x ( plant based ) 2 tablespoon in 1 glass of milk.
- T. ZOFER 4mg / PO / SOS
- Evaluate Anaemia start Iron Supplementation (oral ) after Gastritis ( (resolved )
- TAB NODOSIS
●Patient with coma and renal failure:
Problem list :
-Fever and Diarrhea since 5 days( 4 to 5 times a day with blood discharge.
-Back pain( 5 days ago) with abdominal pain and chest pain.
-Type 2 Diabetes
-infection in the little finger
-Back pain
-severe breathlessness and pain in the chest region.
-fever,pain in abdomen
- Altered Sensorium
--vomiting, loose stools
Diagnostic and therapeutic uncertainty :
-The Laboratory investigations done in this patient are ABG analysis , complete blood picture,kidney function test, liver function tests.
-Parenchyma with (Lt)Abnormal echogenicity, mild hydronephris ,no perinephric collections suggested clinical corelation to Acute pyelonephritis.
-Patient is still in a persistent vegetative state.
-No prognosis is seen.
-Have started treating her with antibiotics.
The Provisional diagnosis of the patient was found to be -DKA with AKI
- USG shows Pyelonephritis.
Treatment for this patient is :
Inj. NORAD 2amp in 50ml NS
Inj. PIPTAZ 2.25gm.
Inj. DOPAMINE 2amp in 50ml
Inj. HAI 1ml in 39ml NS
Inj. PIPTAZ 2.25gm.
Inj. CLEXANE 40gm.
Iv infusion NS RL @100ml/hr.
Problem list :
-abdominal distension
-non healing injury to the right foot
-Diabetes mellitus type 2
-Tingling in the upper limbs up to the palms, in the lower limbs up to the knee.
-Abdominal Distension
-Constipation
-altered Sleep patterns
-pedal edema grade 2
Diagnostic and therapeutic uncertainty :
-The investigations done in this patient are complete urine examination,hemogram,liver function tests,2D echo, ECG.
The final diagnosis was found to be:
INFECTIVE ENDOCARDITIS
WITH AV VEGETATIONS WITH MODERATE AS SEVERE AR
WITH AKI
WITH UREMIC ENCEPHALOPATHY SEPTIC ENCEPHALOPATHY
WITH ULCER OVER SOLE OF RIGHT LEG
WITH HYPOALBUMINEMIA ALCOHOLIC LIVER DISEASE
WITH ACUTE MULTIPLE INFARCTS IN BILATERAL CEREBRAL AND CEREBELLAR HEMISPHERES
The treatment for this patient is :
1. Inj. Monocef 1gm IV/BD
2. Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr
3. Procto clysis enema
4. Inj. Pan 40 mg Iv/OD
5. Inj. Thiamine 200mg in 100ml NS /BD
6. Inj. HAI 6U S/C TID
●Patients with acute on CKD :
Problem list :
-Fever since 4 days
- Pus in the Urine
-type 2 diabetes
-drippling of urine, Hesitation, reduced flow of urine, Difficulty in void initially not associated with suprapubic pain or burning micturition
-Prostomegaly
-preoperative patient sugars were high
-decreased Appetite and Generalised weakness
-drowsiness
-excessive sleep
-Hyponatremia
-fleshy mass like and foamy passage in his urine
The diagnosis was found to be :
Renal AKI secondary to urosepsis with b/L hydroureteronephrosis with K/c/of DM -2 since 5 yrs with diabetic nephropathy with Anemia secondary to CKD with grade 1 bed sore.
The treatment given to this patient is :
-Injection PANTOP 40mg IV/OD
-Injection PIPTAZ 4.5 stat and 2.25 gm IV/ TID
-Injection LASIX 40mg IV/BD
-Injection optineuron 1AMP in 100ml NS slow IV/OD
-Injection NEDMOL 100ml IV/SOS
-Tab PCM 650mg TID
-Insulin Human actrapid - 16 IU/TID
Problem list:
- Shortness of breath
-chronic renal failure
-Chest pain
-heart failure
-orthopnoea
-bendopnoea
-Diabetes mellitus
- Hypertension
-edema of feet
-dysponea
-high blood sugar
The provisional diagnosis was found to be HFrEF secondary to CAD, CRF
The treatment for this patient is
1. TAB. BISOPROLOL 5mg OD
2.TAB. NITROHART 20/37.5mg 1/2 T/D
3.TAB NICARDIA XL 30mg OD
4.TAB. GLICIAZIDE 80mg BD
5.TAB. NODOSIS 500 mg TD
6.Cap. BIO-D3 OD
7.Cap. GEMSOLINE OD
8.TAB. ECOSPRIN-AV 150/20mg OD
9.TAB.LASIX 40mg BD
10. SYP. LACTULOSE 15ml
Problem list :
-Pedal edema
-Decreased urine output
-vomitings and loose stools
-Shortness of breath
-pneumonitis with type 1 Respiratory Failite
- Interstial lung disease,
- Right heart failure .
The treatment for this patient is :
1. Tab. Augmentin
2. Tab. Wysolone 40 mg
3. Tab . Lasix 20 mg
4. Pantop
5. Montek FX -- 1 month.
6.Oxygen inhalation.
●Patients with AKI :
Problem list :
-Loose stools
-pedal edema
-abdominal distension
-swelling of bilateral lower limbs
-TB
The investigations done in this patient are hemogram, complete urine examination, complete blood picture, RFT, LFT, ECG, chest X Ray PA view, USG abdomen APTT, BT/CT.
The provisional diagnosis of the patient was found to be ALCOHOLIC HEPATITIS, AKI SECONDARY TO ACUTE GASTROENTERITIS
-HFrEF SECONDARY TO CAD
Alcoholic AND TOBACCO DEPENDENCE SYNDROME
The treatment given to this patient is:
INJ THIAMINE 100 mg in 100 ml NS slow IV
INJ OPTINEURON 1AMP in 100 ml NS
INJ LASIX 40 mg
TAB. ALDACTONE 50 mg PO / BD
INJ PANTOP 40 mg IV/ OD
ABDOMINAL GIRTH MEASUREMENT
Problem list :
-pedal edema
-decreased urine output
-fever
-DM type 2
-burning micturation
-acute kidney injury
The investigations done in this patient are CUE, ECG, ultrasound, hemogram, bacterial culture and sensitivity test.
The provisional diagnosis of patient was Acute kidney injury secondary to urosepsis with hyperkalemia(resolved)
With anemia of chronic disease.
The treatment given to this patient is :
Inj LASIX 40 mg IV/TID
IVF - NS @ UO + 50 ml/hr
Inj MAGNEXFORTE 1.5 gm/IV/BD
Tab NODOSIS - 500 mg PO/OD
Tab OROFEA - XT PO/OD
Inj HAI s/c
Neb plain Asthalin 2 respules QID
Problem list :
-pain in the abdomen
-vomiting
-Shortness of breath
-scrotal and Penile swelling
The provisional diagnosis is :
Acute pancreatitis with AKI
With B/L pleural effusion and moderate ascitis.
The treatment given to this patient is:
Iv fluids : NS 40 ml /hr.
IV lasix 40 mg BD .
Tab nodosis
IV PIPTAZ 4.5 Gms. BD
Iv 25%Dextrose. 100 ml BD
Tab . Nicardia 10 mg TID.
QUESTION 5 : Please reflect on and share your telemedical learning experiences from the hospital as well as community patients over the last month particularly while you are e logging their case case report while even in hospital or perhaps when locked down at home.
ANSWER:
The first thing I thank GM department for giving us such opportunity to make blog. the every log and and every case are very useful for us to understand and get a clarity on patient centered data and treatment for the patient. During this pandemic its highly impossible for us to know about clinicals. In that situation GM medicine department helped us a lot for understanding a case oriented details. They clearly explained about everything about how the patient will be, what should we do, what investigations should be done, everything they clearly explained. and now we can easily go for postings and we can easily grab the info from the patient and what to be done further, I got up with a good knowledge. Thank you for GM department.
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